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Does Stoma-Site Extraction Increase Stoma Complications?
Wanglin Li*, Cigdem Benlice, Luca Stocchi, Hermann Kessler, Emre Gorgun, Feza H. Remzi, Meagan Costedio
colorectal department, Digestive disease institute, Cleveland, OH
Background: Minimally invasive surgery has become the mainstay of many colorectal procedures with demonstrated short term benefits over open surgery. Minimizing incisions potentially decreases hernia formation and wound complications. It is currently unknown if using the stoma site for specimen extraction increases stoma complications. This study aims to evaluate the impact of stoma site extraction on postoperative complication rates in laparoscopic colorectal surgery.
Methods: After IRB approval a retrospective comparative review of 738 consecutive patients (405 M) who underwent laparoscopic colorectal surgery with ileostomy/colostomy between January 2008 and December 2014 was performed. Patients who had a minimally invasive surgery that required a temporary or permanent stoma were included. Patients were excluded for a perineal extraction site, open surgery or less than 6 month follow up. Patients were classified into two groups: stoma site extraction or non-stoma site extraction and compared by body mass index (BMI), age, comorbidities, American Society of Anesthesiologists score (ASA), length of stay (LOS), blood loss (EBL), parastomal complications, and hernia rate.
Results: The para-stomal hernia rate was 14/139 (10.07%) for the stoma-site extraction group and 25/599 (4.17%) for the non-stoma site extraction group p = 0.0051. 8 patients from the stoma site extraction group experienced stomal prolapse, retraction, stenosis, strangulation, or abscess, while 5 patients of the 599 patients with non-stoma site extraction had such issues. The number of patients who required additional surgery was 8/139(5.76%) for the stoma-site extraction group and 28/599(4.67%) for the non-stoma site extraction group p=0.6611. There was no difference in the hernia rate from other incision sites or the stoma site after stoma closure. There were no statistically significant differences in BMI, age, comorbidities, ASA score. LOS and EBL were both decreased in the stoma site extraction group.
Conclusion: Stoma site specimen extraction does not increase stoma site complications. Despite the fact that stoma site extraction is associated with an increase in parastomal hernia, this increase did not translate into additional surgeries or postoperative sequlae after the stoma was reversed. Extraction from the stoma-site appears to be safe and feasible particularly in patients with temporary stomas.
Table1. Patient demographics
| | Stoma site extraction | Nonstoma site extraction | P value | | Patients (n) | 139 | 599 | | | Age (median) | 41±14 | 43±16 | 0.26 | | ASA score (median) | 5.66±0.48 | 5.84±0.24 | 0.3915 | | BMI (median) | 25.63±5.66 | 26.09±5.84 | 0.3915 | | DM | 4 | 29 | 0.2833 | | COPD | 1 | 4 | 0.9490 | | Renal failure | 0 | 6 | 0.2265 | | Operative time (minutes) | 190.06±80.53 | 225.83±76.06 | <0.0001 | | EBL (ml) | 124.23±131.98 | 199.24±222.85 | 0.0001 | | LOS (days) | 6.33±4.38 | 7.19±5.39 | 0.0528 | | Follow up interval (months) | 25.17±15.12 | 36.65±20.61 | 0.0001 |
*Data were given as; mean ± standard deviation (minimum - maximum), BMI: Body Mass Index; ASA: American Society of Anesthesiologists; DM: Diabetes Mellitus; COPD: Chronic Obstructive Pulmonary Disease; EBL: Estimated Blood Loss LOS: Length of Stay Table 2 Postoperative complications | | Stoma site extraction | Nonstoma site extraction | P value | | Stoma complications | | | | | Hernia | 14 | 25 | 0.0051 | | Prolapse | 2 | 2 | | | Retraction | 1 | 0 | | | Stenosis | 2 | 1 | | | Strangulation | 1 | 1 | | | Abscess | 2 | 1 | | | Reoperation | 8 | 28 | 0.6611 | | Non-Stoma complications | | | | | Incision site hernia | 2 | 22 | 0.1810 | Stoma site hernia
(after closure)
| 1 | 11 | 0.3482 |
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